High Dose-rate Intracavitary Brachytherapy in Elderly Patients with Cervical Cancer

Purpose/Objective(s)To report technical aspects and feasibility of high dose-rate intracavitary brachytherapy in elderly women with cervical cancer.Materials/MethodsFrom May 2000 through June 2006, 544 intracavitary brachytherapy insertions were performed for patients diagnosed with advanced (IIIB) cervical carcinoma. Three hundred and forty-four (64%) were done in patients with less than 70 years old (median 49-years-old) and 200 (36%) in patients with more than 70 years old (median 76-years-old). Each patient received a mean of 3.8 insertions (median 4) all with high dose-rate after-loading Fletcher applicators. All patients were previously treated with external beam radiotherapy with a four-field technique (box) with median dose of 54 Gy. General anesthesia was not routinely performed for the brachytherapy insertions.ResultsThe older and the younger patients group were found homogeneous in some characteristics: teletherapy and brachytherapy doses (51 vs. 52 Gy and 26 vs. 27 Gy, respectively), hysterometry (57 vs. 58mm) and involvement of lower vagina (11 vs. 10%). In others, there was an expected difference between the groups, with the older women receiving less chemotherapy (12 vs. 29%; p = 0.03) and shorter total treatment time (59 vs. 62 days; p = 0.01). Some small differences were found in technical aspects with older women using smaller vaginal Fletcher ovoids (36% mini, 46% small vs. 18% mini, 58% small; p = 0.01), less vaginal packing (64 vs. 76%; p = 0.002) and greater doses on rectum (75x70%, p = 0.0001) and bladder (66x60%; p = 0.0001) ICRU points. Our major results showed that there was no concern with safety in relation to intracavitary application for elderly women, with the older patients requiring similar proportion of anesthesia (22 vs. 25%; p = 0.4) and post-insertion analgesic medication (22 vs. 29%; p = 0.08) than the younger ones. Older women also had similar incidence of treatment interruptions (12 vs. 14%; p = 0.6).ConclusionsHigh dose rate intracavitary brachytherapy is safety and technically viable procedure for elderly women with cervical cancer. Purpose/Objective(s)To report technical aspects and feasibility of high dose-rate intracavitary brachytherapy in elderly women with cervical cancer. To report technical aspects and feasibility of high dose-rate intracavitary brachytherapy in elderly women with cervical cancer. Materials/MethodsFrom May 2000 through June 2006, 544 intracavitary brachytherapy insertions were performed for patients diagnosed with advanced (IIIB) cervical carcinoma. Three hundred and forty-four (64%) were done in patients with less than 70 years old (median 49-years-old) and 200 (36%) in patients with more than 70 years old (median 76-years-old). Each patient received a mean of 3.8 insertions (median 4) all with high dose-rate after-loading Fletcher applicators. All patients were previously treated with external beam radiotherapy with a four-field technique (box) with median dose of 54 Gy. General anesthesia was not routinely performed for the brachytherapy insertions. From May 2000 through June 2006, 544 intracavitary brachytherapy insertions were performed for patients diagnosed with advanced (IIIB) cervical carcinoma. Three hundred and forty-four (64%) were done in patients with less than 70 years old (median 49-years-old) and 200 (36%) in patients with more than 70 years old (median 76-years-old). Each patient received a mean of 3.8 insertions (median 4) all with high dose-rate after-loading Fletcher applicators. All patients were previously treated with external beam radiotherapy with a four-field technique (box) with median dose of 54 Gy. General anesthesia was not routinely performed for the brachytherapy insertions. ResultsThe older and the younger patients group were found homogeneous in some characteristics: teletherapy and brachytherapy doses (51 vs. 52 Gy and 26 vs. 27 Gy, respectively), hysterometry (57 vs. 58mm) and involvement of lower vagina (11 vs. 10%). In others, there was an expected difference between the groups, with the older women receiving less chemotherapy (12 vs. 29%; p = 0.03) and shorter total treatment time (59 vs. 62 days; p = 0.01). Some small differences were found in technical aspects with older women using smaller vaginal Fletcher ovoids (36% mini, 46% small vs. 18% mini, 58% small; p = 0.01), less vaginal packing (64 vs. 76%; p = 0.002) and greater doses on rectum (75x70%, p = 0.0001) and bladder (66x60%; p = 0.0001) ICRU points. Our major results showed that there was no concern with safety in relation to intracavitary application for elderly women, with the older patients requiring similar proportion of anesthesia (22 vs. 25%; p = 0.4) and post-insertion analgesic medication (22 vs. 29%; p = 0.08) than the younger ones. Older women also had similar incidence of treatment interruptions (12 vs. 14%; p = 0.6). The older and the younger patients group were found homogeneous in some characteristics: teletherapy and brachytherapy doses (51 vs. 52 Gy and 26 vs. 27 Gy, respectively), hysterometry (57 vs. 58mm) and involvement of lower vagina (11 vs. 10%). In others, there was an expected difference between the groups, with the older women receiving less chemotherapy (12 vs. 29%; p = 0.03) and shorter total treatment time (59 vs. 62 days; p = 0.01). Some small differences were found in technical aspects with older women using smaller vaginal Fletcher ovoids (36% mini, 46% small vs. 18% mini, 58% small; p = 0.01), less vaginal packing (64 vs. 76%; p = 0.002) and greater doses on rectum (75x70%, p = 0.0001) and bladder (66x60%; p = 0.0001) ICRU points. Our major results showed that there was no concern with safety in relation to intracavitary application for elderly women, with the older patients requiring similar proportion of anesthesia (22 vs. 25%; p = 0.4) and post-insertion analgesic medication (22 vs. 29%; p = 0.08) than the younger ones. Older women also had similar incidence of treatment interruptions (12 vs. 14%; p = 0.6). ConclusionsHigh dose rate intracavitary brachytherapy is safety and technically viable procedure for elderly women with cervical cancer. High dose rate intracavitary brachytherapy is safety and technically viable procedure for elderly women with cervical cancer.